Remember the simple physiology of what occurs:
- The lungs transition from fluid filled to air filled- this may not occur as perfectly in those children that are preterm, or those that are via caesarean.
- Pulmonary blood flow increases by 5-6 times
- Intra/extra cardiac shunts close.
Because of this, it takes 5-10 minutes for oxygen levels to rise to 90%
If airway needs attending, place the newborn on its back in the sniffing position.
DO NOT perform pharyngeal suction as this can lead to laryngeal spasm (unless there are objects that need to be cleared)
If meconium is present in a vigorous baby- suctioning is discouraged. If in a non-vigorous baby, it may assist although no great evidence.
Positive pressure Ventilation should be initiated with a T-piece device, but a bag-valve-mask can be used for backup.
On devises that deliver PEEP use 5cm H2O- beware as >8cm H2O is associated with pneumothorax.
Initial pressures are 30cm H2O for term infants and 20-25cm H2O for premature infants. Beware high pressures in preterm infants.
Judge the effectiveness of the ventilation by:
- chest rise
- Heart rate > 100
- Improved oxygenation
The pressure may need to be altered.
Beware too much oxygen. It may be harmful to neonates after resuscitation.
The table shows targets to aim for. However the maximum at 10 minutes should be 90%